| NPI | 1811020225 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN J RUSSELL President 573-335-4209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 100521) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 100521) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-08-22 |