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