| NPI | 1619145612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI JANE ROBERTS Owner 573-620-6444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: MO 2005013758) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2011-09-08 |