| NPI | 1417695685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CONOVER Cro 573-603-1460 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2022-05-26 |