| NPI | 1316571656 |
|---|---|
| Doing Business As | OLD TOWN PAABS |
| Entity Type | Organization |
| Authorized Contact | SHANE BECKER Authorized Official / D Irector 417-635-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-03-09 |