| NPI | 1518629229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORRINE DALE Chief Medical Officer 314-216-0199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2021-10-11 |