| NPI | 1285241877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY A MITROKA President CEO 618-724-2436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2020-10-02 |