| NPI | 1043404114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER RENE STALCUP Doctor 314-315-2868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: MO 2007021516) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2012-02-24 |