| NPI | 1487863254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI ALLISON KHAZEN Owner 314-368-9772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2000157569) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |