| NPI | 1760032965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FERNANDO BORREGO Director 573-783-8875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care |
| 261QP1100X Clinic/Center, Podiatric | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2020-05-28 |