| NPI | 1023582038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA LYNN FISHER CEO 618-993-0404 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2026-04-29 |