| NPI | 1093092413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA JEAN WEBER Lcsw 314-452-1529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO 2011035620) |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2012-02-14 |