| NPI | 1497823314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE WAYNE MELVIN Executive Director 618-242-2745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: IL 001) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2022-07-21 |