| NPI | 1477880581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN O WILSON Office Manager 636-219-6634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MO 2009025407) |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2012-05-31 |