| NPI | 1194033704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES B. DAVIS Executive Director 618-257-4644 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2013-02-25 |