| NPI | 1407169766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA ANN RENGO-KOCHER Owner 636-300-3948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MO SW000377) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2010-07-15 |