NPI | 1164889879 |
---|---|
Entity Type | Organization |
Authorized Contact | ANGELA SLATER Owner/Director 314-942-9280 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization |
Additional Taxonomies | 305S00000X Point of Service |
Enumeration Date | 2016-01-26 |
Last Update Date | 2016-01-26 |