| NPI | 1376853994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI BLAGG Business Manager 618-628-0715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: IL 036101869) |
| Additional Taxonomies | 207YS0012X (Licence: IL 036101869) |
| Enumeration Date | 2010-10-16 |
| Last Update Date | 2020-11-03 |