| NPI | 1053503714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW BERMAN Owner 314-862-5700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO 2001030176) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2014-06-17 |