| NPI | 1790818599 |
|---|---|
| Other Name | C/O RAMIRO ICAZA |
| Entity Type | Organization |
| Authorized Contact | RAMIRO ICAZA Administrator 573-243-2154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO MDR7D79) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-02-06 |