| NPI | 1982777413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL M QUALLEY Physician,Owner 636-561-4613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO 2004011011) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2020-08-22 |