| NPI | 1992762942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES R. LEWIS Administrator 417-782-2504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MO 006161) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MO 20044021789) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2016-07-25 |