| NPI | 1144564196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BHARATHI RAJU Sole Member 636-236-5820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MO 2001005643) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2019-09-16 |