| NPI | 1184653800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN COLBERT -THREATS President 314-361-9070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: MO 109362) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-08-22 |