| NPI | 1790263200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODNEY D GROSS CEO 573-915-1313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2019-08-02 |