| |
200 N Main St Ste G51 Rolla MO 65401-3070 | |
(573) 458-6010 | |
(573) 458-6060 |
Full Name | |
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Speciality | Clinic/center - Public Health, State Or Local |
Location | 200 N Main St, Rolla, Missouri |
Authorized Official Name and Position | Josephine P Waltman (ADMINISTRATOR) |
Authorized Official Contact | 5734586010 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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200 N Main St Ste G51 Rolla MO 65401-3070 Ph: (573) 458-6010 | 200 N Main St Ste G51 Rolla MO 65401-3070 Ph: (573) 458-6010 |
NPI Number | 1427051069 |
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Provider Enumeration Date | 05/27/2005 |
Last Update Date | 08/15/2007 |
Identifier | Type | State | Issuer |
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1427051069 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP0905X | Clinic/center - Public Health, State Or Local | N/A (Missouri) | Primary |
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