| NPI | 1669915799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENIA MOSLEY Student 314-602-7722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA 713834) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2016-11-21 |