| NPI | 1639616113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN DENISE BLACKWELDER Owner 573-475-7333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: MO 114108) |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2017-01-23 |