| NPI | 1013677293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW MARSHALL Office Manager 314-647-2200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QR0200X Clinic/Center, Radiology | |
| Enumeration Date | 2021-12-29 |
| Last Update Date | 2024-06-11 |