| NPI | 1538838560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH SPARKS Credentialing Specialist 573-426-2407 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2021-11-19 |