| NPI | 1710982699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JOHNSON Administrator 573-406-1301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MO 108) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2010-10-21 |