| NPI | 1033699467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY M GALLON Designated Official 314-495-6037 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2019-07-29 |