| NPI | 1992142418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS MATTHEW GIBBONS Owner 573-651-0660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MO T03048) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2013-09-17 |