| NPI | 1336755941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMELIA DORIS LEDBETTER Director Of Operations 573-335-4715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2020-09-18 |