| NPI | 1710022108 |
|---|---|
| Other Name | FAYETTE OUTPATIENT CLINIC |
| Entity Type | Organization |
| Authorized Contact | ALLEN TACKER Executive Director 573-443-2204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-08-22 |