| NPI | 1548865876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DAVID CHURCH Vice President Of Finance 618-972-5228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-12-03 |
| Last Update Date | 2024-09-23 |