| NPI | 1619965324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELINDA SMITH Administrator 314-205-1610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MO 132-0) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2014-08-11 |