| NPI | 1922796408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DI'ARA WOODS CEO 314-749-8906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2023-04-24 |