| NPI | 1508237926 |
|---|---|
| Doing Business As | FCC'S FAMILY PRACTICE CLINIC |
| Entity Type | Organization |
| Authorized Contact | LARRY SHAWN SANDO Chief Operating Officer 573-888-5925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2015-10-12 |