| NPI | 1932358421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACK E MCCAIN President 314-522-1834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MO r6f90) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2011-10-11 |