| NPI | 1023195351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN L THRELKELD Physician Registered Agent 636-390-1854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO MDR5P58) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-10-10 |