| NPI | 1720450216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J BUKSTEIN Physician Exec Director 573-231-3172 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2022-04-18 |