| NPI | 1114252004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA LEA DAVIS Clinical Case Manager 314-206-3494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MO 2009007494) |
| Additional Taxonomies | 251B00000X Case Management (Licence: MO 2009007494) |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2009-10-09 |