| NPI | 1205212917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER BLUE Contracting Manager 636-978-0970 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: GA CHIR009505) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2016-06-16 |