| NPI | 1497765994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JOSEPH LASTRAPES Physician 573-335-8282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 112343) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2008-05-30 |