| NPI | 1962675744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT J LOBONC Md 636-441-4144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MO R7C25) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2008-04-11 |