NPI | 1629135108 |
---|---|
Entity Type | Organization |
Authorized Contact | LAURAIN CARROLL HENDRICKS Physician Owner 314-395-3575 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2004001454) |
Enumeration Date | 2007-01-03 |
Last Update Date | 2020-08-22 |