| NPI | 1023058484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEATRICE LUMAE KELLOGG Owner 618-257-2029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: IL 036097679) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2008-09-17 |