| 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 |