| NPI | 1871117937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT VANGILDER CFO 314-800-6161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2022-11-18 |