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 |