| NPI | 1316015753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL KUNDRICK Officer 618-656-0451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-023553) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2020-08-22 |