| NPI | 1164921474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER ANN ROGERS Administrative Services Manager 573-765-5131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2018-02-02 |