| NPI | 1144495599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL JEWELL FAHNESTOCK President 660-886-6903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO 003184) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-05-30 |