| NPI | 1295182905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN JOSEPH CISNEROS Owner 618-281-9590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019024628) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2016-05-23 |