| NPI | 1205361110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES DAVIS Executive Director 618-257-4644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036113800) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2017-04-28 |