| NPI | 1952645459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE A. BUTLER President & CEO 314-367-7848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2012-11-21 |
| Last Update Date | 2013-02-04 |