| NPI | 1063838357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAKEEL AHMED Owner 618-239-0678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 7003185) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2014-03-11 |