| NPI | 1437372364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK E RICKETTS Owner President 636-343-1144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO R5C65) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2008-02-26 |