| NPI | 1750325585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANET L GRAVITT Office Manager 660-263-5787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO 106165) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2020-08-22 |