| NPI | 1588941702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA W TANNER President 636-296-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO 006005) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2011-11-16 |