| NPI | 1114149739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYCE LANXON Executive Director 314-977-6828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0201X Internal Medicine Allergy & Immunology |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2021-09-21 |