| NPI | 1053413740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUIS ALBERTO LOPEZ President/Physician 618-993-5274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2020-09-01 |