| NPI | 1134442726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY E BRAGG Managing Member 314-494-6337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 056005465) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2010-03-10 |