| NPI | 1316764871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY MARIE RENNER Billing Assistant 618-282-6233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2024-09-25 |
| Last Update Date | 2024-09-26 |