| NPI | 1740587948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY M RUNDQUIST Program Director 636-583-6115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MO 1262-10795) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2011-02-24 |