| NPI | 1205023405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH BURTON Practice Manager 636-530-6161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MO 13172549) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2007-10-02 |