| NPI | 1528441276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY BULLINGTON Missouri Regional Physician Recruit 573-635-5315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2400X Clinic/Center, Prison Health (Licence: MO 2015015777) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2015-06-30 |