| NPI | 1255873253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE M LONGO Owner 314-778-3222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2016-11-08 |