| NPI | 1710261623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY ADDERLEY Credentialing 314-432-2580 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IL 036109093) |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2011-10-11 |