| NPI | 1275019408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL MIMLITZ Manager 314-394-1660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MO 2017006602) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2018-07-11 |