| NPI | 1174743702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | R(RAY) WILLIAM BURMEISTER Medical Director 314-842-4920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO 25858) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-08-22 |