| NPI | 1346659836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOYCE NICOLE DAVIS Owner/Director 314-361-2178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MO LC9745994) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2014-08-08 |