| NPI | 1316385990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN S ENDICOTT-PLOG Clinical Director / Sole Proprietor 618-233-3273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 149.008683) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2013-06-05 |