| NPI | 1619248853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHOTCHAI BOONKHAM Owner 314-291-3717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO 34210) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2012-01-19 |