| NPI | 1962172304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY E BROTHERTON Business Consultant 573-268-0967 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2021-09-16 |