| NPI | 1124347489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN ALPHONSE RISSE Owner 636-933-4870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MO 2005038598) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2010-05-26 |