| NPI | 1952958449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER GAST Administrator 573-803-3331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207N00000X Dermatology |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2019-08-20 |