| NPI | 1336179951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIO L GOSPODINOFF Owner 618-252-4956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036040279) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-08-22 |