| NPI | 1770886897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA ROCHELLE MOORE CEO 314-382-6090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO #2955 & #3100) |
| Enumeration Date | 2010-12-10 |
| Last Update Date | 2010-12-10 |