| NPI | 1114129970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA LYNN FISHER Office Manager 618-993-0404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2023-09-29 |