| NPI | 1720374176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HARRY D BURACK Owner 636-928-3858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MO R9806) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2011-06-23 |