| NPI | 1295839702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVE HORACE Business Manager 314-909-1666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 109216) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-08-22 |