| NPI | 1013980366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYCE LANXON Executive Director 314-977-6828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2021-09-21 |