| NPI | 1093853350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARRIS JACKSON Physician 636-937-3121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MO R9F09) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2007-10-05 |