| NPI | 1356832653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY RYAN VAUGH Adult Nurse Practitioner 314-488-3464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2018-05-22 |