| NPI | 1124679774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMELIA DORIS LEDBETTER Director Of Operations 573-335-4715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2023-06-12 |