| NPI | 1326348152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ALAN NOLEN President 618-937-4164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: IL 038003613) |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2010-10-27 |