| NPI | 1912160433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEO WARREN Physician 636-821-2500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MO R7N81) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2008-07-03 |