NPI | 1215259106 |
---|---|
Entity Type | Organization |
Authorized Contact | DARRELL GEORGE PROVINSE L.P.C., N.C.C 314-746-9622 |
Organization Subpart ? | No |
Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MO 2009036114) |
Enumeration Date | 2010-02-19 |
Last Update Date | 2010-02-19 |