| NPI | 1851757538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSHANDA A GRIFFIN Manager/Owner 314-498-3237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MO 22654356) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2016-01-11 |