| NPI | 1538860200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER GREEN Medical Director 618-409-2122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2024-03-15 |