| NPI | 1427102615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA L. BOWMAN President 618-632-2282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019022429) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-08-22 |