| NPI | 1023297553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEFFIELD BOARDMAN Medical Director 618-549-5361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2018-06-21 |