| NPI | 1073880423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WYNNDEL BUENGER Manager 618-465-7177 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: IL 038008971) |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2011-11-29 |