| NPI | 1871500967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | POLLY J JOHNES Administrator 314-373-2063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MO 153-1) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2020-08-22 |