| NPI | 1518140011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA RENEE CHAMBERLIN Office Administrator 314-750-0935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO R6907) |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2008-11-13 |