| NPI | 1578098471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN KANE Supervising Physician 573-825-6097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: GA 7919) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2017-04-28 |