| NPI | 1023584232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORINTHIA DARCEL JAMISON Credentialing COO Rdinator 314-814-8531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2021-09-27 |