| NPI | 1225191752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONA WELLS CFO 573-339-1196 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2010-10-15 |