| NPI | 1972596088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA R CLABON CEO 314-367-5820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2018-06-27 |