| NPI | 1548750847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY A ROEBACK Chief Executive Officer 573-438-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: H80CS06670-13-02) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2018-05-14 |