| NPI | 1376536953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L JOHNSON CEO 573-438-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2009-06-23 |