| NPI | 1568403079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY J PARCIAK Office Manager 314-432-2580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO 2002008093) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 27599) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2008-09-24 |