| NPI | 1144694480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WILLIAMS Authorized Official 636-272-8891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2009009432) |
| Enumeration Date | 2015-11-24 |
| Last Update Date | 2015-11-24 |