| NPI | 1306128269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT T FOY Owner 314-647-5047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MO 2002005721) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MO 2002005721) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2020-05-21 |