| NPI | 1528262474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE MARIE HICKS Owner 314-374-9399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MO 2007007207) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2020-08-22 |