| NPI | 1508158445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENELLE LOFQUIST Owner 636-825-6555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: MO 2011012193) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2011-07-13 |