| NPI | 1235407198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA NOBLES Owner 314-629-6497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO J035159009) |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2011-12-07 |