| NPI | 1558857086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY J KEELE Owner 573-803-2941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: MO 2002008827) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2018-07-09 |