| NPI | 1508308578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN WARREN Director 314-322-3994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MO LC9814999) |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2016-11-08 |