| NPI | 1366432130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANIL GUPTA Owner 618-244-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 060-008820) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2020-08-22 |