| NPI | 1043539521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN SCHRANCK Business Administrator 314-336-2570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center Pain (Licence: MO 2009025407) |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QR0400X Clinic/Center Rehabilitation | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2010-05-24 |