| NPI | 1891123477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA PULLUM Director 636-669-2434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 2004019662) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2013-10-17 |