| NPI | 1013154160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN MICHELLE LICAVOLI Office Manager 314-432-0056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO 103604) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2009-01-12 |