| NPI | 1124335286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY FRIDLEY Single Member 636-332-1769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MO 2000161195) |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2010-09-09 |