| NPI | 1548337942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MARIA DE LA TORRE Administrator 573-468-6011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 33207) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-08-22 |