| NPI | 1487401709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER NICOLE TERWILLIGER Credentialing Specialist 636-556-0114 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2024-05-03 |
| Last Update Date | 2024-05-03 |