| NPI | 1336278423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL L GARDINE Executive Director 314-731-0100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: MO 261QM2800X) |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2020-01-30 |