| NPI | 1639456064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN BOYER Psychiatrist 314-725-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO 103713) |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2012-02-13 |