| NPI | 1396284303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC JEROME FULNECKY Owner 417-459-1711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: MO 2004006990) |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2017-02-23 |