| NPI | 1811392210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN T ELLENA Medical Director 314-996-3434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.108281) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2014-11-12 |