| NPI | 1093092611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORETTA BENEDICK Practice Manager 314-366-4874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO 2011030112) |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2025-04-24 |