| NPI | 1568650885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM LIESEL PIERCE Payroll, Medicaid Clerk 573-614-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MO 506180405) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2007-10-11 |