| NPI | 1497925184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANINE MARIE HUDDLESTUN-JOHNS Owner 618-783-3714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019020343) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2008-03-10 |