| NPI | 1073595096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOETTA MARTIN Administrator 573-785-0851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: MO 031640) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2008-07-10 |