| NPI | 1962924217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEIDI PAULSEN Practitioner / Owner 636-345-2375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MO 2012017906) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2022-07-21 |