| NPI | 1811160914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN PATRICK O'DONNELL Owner 636-537-2702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO MDR5B99) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2008-04-09 |