| NPI | 1275629081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN PAINTER Credentialing Supervisor 314-989-0300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: ME 36363) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2022-07-28 |