| NPI | 1023123346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA G DEATON Administrator 618-993-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: IL 036099669) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2012-03-16 |