| NPI | 1679013643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTAY K REED Owner 314-853-0469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MO LC001491707) |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2017-02-24 |