| NPI | 1508867508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MADDOX Chief Financial Officer 314-481-1615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2022-07-21 |