| NPI | 1669788063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA EISENBATH Office Manager 636-332-6660 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 35018) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 35018) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2010-08-23 |