| NPI | 1649560558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN OGBEVOEN President 314-283-9198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO 103771) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2011-04-12 |