| NPI | 1336328186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELETH T JOSEPH Administrator 618-993-8282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 036045640) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: IL 036045640) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2007-11-29 |