| NPI | 1538394556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN W. BURTON President 618-519-9363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2009-05-19 |