| NPI | 1285358481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BOEDEFELD Owner/Medical Director 636-706-0560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2022-09-30 |
| Last Update Date | 2024-04-11 |