Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2006-06-18
- Last updated
- 2017-11-01
Specialties
Licenses
- License MO
- 2011020757
- License MO
- 2011020757
Location
- Practice location
- 105 W ELDON ST
- City
- SAINT JAMES MO
- Postal code
- 655591903
- Phone
- 573-265-8901
Organization contact
- Name
- PATRICK BERRY
- Title
- Chief Operating Officer
- Phone
- 3146285606
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.