| NPI | 1144596263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUNE WALKER Director 314-989-1002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO 1007) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2012-03-23 |