| NPI | 1174535900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLADSTONE A TUCKER Owner 618-542-6152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: IL 036111926) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2012-07-25 |