| NPI | 1932534104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY JEROME WILHITE Owner 314-780-4483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MO N137246015) |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2013-09-06 |