| NPI | 1235103003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE DWAYNE HELTON Owner 636-677-9977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2006025334) |
| 207Q00000X Family Medicine (Licence: MO R6F69) | |
| 207R00000X Internal Medicine (Licence: MO DO113093) | |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2008-08-14 |