| NPI | 1720272834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RENEE PUCKETT Physician, Owner 573-888-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: MO 2006013170) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2006013170) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2008-02-07 |