| NPI | 1629432182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESS MARIE GENEL Billing Specialist 417-476-1013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2022-07-21 |