| NPI | 1275676355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY L MOSS Office Manager 573-785-2005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 208D00000X General Practice |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2017-10-05 |