| NPI | 1568742211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORTHY J EVANS Pharmacist 618-394-8744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: IL 051-036497) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2011-08-25 |