| NPI | 1336258540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK R FREELAND Executive Director 618-874-3120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-07-06 |