| NPI | 1790213676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOAN L MAYBERRY Office Manager 573-204-1400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: MO 106442) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2017-05-25 |