| NPI | 1548240211 |
|---|---|
| Other Name | REA CLINIC BENTON |
| Entity Type | Organization |
| Authorized Contact | KIM A MITROKA President CEO 618-724-2436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2020-08-22 |