| NPI | 1295996023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANASTASIA DEACON Administrator 314-723-0414 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: MO 2002021770) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2008-10-21 |