| NPI | 1245457571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE HEINE Officer 618-524-7303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: IL 019024337) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |