| NPI | 1154747400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHRON BROOKS Sole Podiatrist 618-293-1785 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: IL 016004697) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2014-03-11 |