| NPI | 1700233145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUNTAY RENEA MCCOLLOUGH Executive Assistant/Ap&Ar 314-367-8989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2016-05-16 |