| NPI | 1073022000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN T ELLENA Medical Director 314-996-7644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2025-09-03 |