| NPI | 1053631770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS LORAN MOORE Member 417-926-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MO T03463) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2017-02-20 |