| NPI | 1174947998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER R MCCARTY Owner 573-774-5004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MO 21892466) |
| Enumeration Date | 2014-02-13 |
| Last Update Date | 2014-02-13 |