| NPI | 1073217204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CHURCH VP Of Finance 618-972-5228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-04-19 |