| NPI | 1689909905 |
|---|---|
| Former Legal Business Name | NA |
| Entity Type | Organization |
| Authorized Contact | JEAN J RILEY Clincial Case Manager 573-756-5353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2009-10-05 |