| NPI | 1023493624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONI MCNAMEE Owner/Lpn 618-741-3474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 69992226) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2015-07-23 |