| NPI | 1932521648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY GRESHAM RN, Apn, Member 573-714-6337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO R9B65) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: MO 126637) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2014-01-15 |