| 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 |