| NPI | 1457881963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY L MOSS Office Manager 573-785-2005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2017-06-16 |
| Last Update Date | 2022-07-21 |