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 |