| NPI | 1881961829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTY WILLIAMS Owner 314-372-6702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO 2010040254) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2011-11-18 |