| NPI | 1881817187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN JOSEPH MARTIN Physician 636-916-9525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO 107386) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |