NPI | 1184690570 |
---|---|
Entity Type | Organization |
Authorized Contact | LAXMAIAH MANCHIKANTI Medical Director 618-997-7820 |
Organization Subpart ? | No |
Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 7002900) |
Enumeration Date | 2006-02-24 |
Last Update Date | 2011-10-05 |