| NPI | 1477216539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE PARKS Incorporator 573-864-8733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-10-15 |
| Last Update Date | 2023-12-28 |