| NPI | 1093170003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK G BRUNK Owner/Partner 618-283-2929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019019107) |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2017-02-09 |