| NPI | 1376030874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY SHANE GUTHRIE Privileging Coordinator 573-888-5925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2019-05-08 |