| NPI | 1447520168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY BRAGG Owner/Manager 618-690-0068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: IL 056.009598) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-01-11 |