| NPI | 1013269984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARL GUNDERSEN Member 618-876-0653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 036105102) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2012-10-02 |