| NPI | 1174057178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH COLBERT President 573-775-2636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 013305) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2017-04-17 |