| NPI | 1356650915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAKEL AHMED President 618-239-0678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 036107831) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2010-09-30 |