| NPI | 1336547199 |
|---|---|
| Former Legal Business Name | NONE |
| Entity Type | Organization |
| Authorized Contact | JOHN BARLOW MARTIN Physician 314-725-2618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care (Licence: MO 26157) |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2014-12-10 |