| NPI | 1215944152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUGUSTINE EBONG President/Agent 618-253-8863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health (Licence: IL 148973) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2020-08-22 |