| NPI | 1134433659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK FLOYD ADDERLEY Member 314-288-9161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2007032281) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2024-06-12 |