| NPI | 1386053122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY DUEY Office Manager/Acting Physician 636-236-9614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X (Licence: MO 2013013356) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2014-08-06 |