| NPI | 1902121171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER ALAN UTRUP Owner 314-750-6109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO 2007024823) |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2010-03-31 |