| NPI | 1013896760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA LYNN WIBLE Owner And Nurse Practitioner 618-558-7179 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2025-08-28 |
| Last Update Date | 2025-08-28 |