| NPI | 1487426623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY SMITH Owner/Manager 314-504-2493 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2023-10-23 |