| NPI | 1639582604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLYE HOLTGRAVE Supervisor 314-739-4503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: MO 2013026259) |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2014-06-08 |