| NPI | 1215467733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY M ROBERTS Owner 573-747-1510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2022-07-21 |