| NPI | 1538584594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY DALE LEECH Chief Of Staff 314-972-3107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MO 713780001) |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2014-09-22 |