| NPI | 1679760904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT D TAGUE Owner 314-543-5969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO R8E10) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2015-07-02 |