| NPI | 1689181398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOSEPH GLICKERT Owner 314-567-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2013042448) |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2018-04-09 |