| NPI | 1306003454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANN BISCHOF Owner 636-271-3600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO 2004026180) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2008-05-16 |