| NPI | 1134577653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNNE FULKS Director Of Administrative Services 573-751-8142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2019-08-26 |