| NPI | 1568729028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONTE D MCCLARY Member 314-731-7788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO 2001022829) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2012-04-20 |