NPI | 1295069813 |
---|---|
Entity Type | Organization |
Authorized Contact | CHERICE R. MADISON Owner 314-363-0732 |
Organization Subpart ? | No |
Primary Taxonomy | 251X00000X (Licence: MO 0000000000000) |
Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: MO 000000000000) |
Enumeration Date | 2009-09-29 |
Last Update Date | 2009-09-29 |