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 |