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 |