| NPI | 1396008579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC DOUGLAS DIXON Owner/Operator 618-791-2983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: IL 038012183) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2012-06-21 |