| NPI | 1801084421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA LYNN ROTH Ofice Manager 636-294-5757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MO r9j58) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2012-11-29 |