| NPI | 1184687386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER HARTSHORN Officer/Authorized Official 314-800-2017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: OH 139) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: OH 36D0711013) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2024-10-28 |