| NPI | 1578734489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS JOSEPH FEDER President 618-235-5141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019.013814) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2008-03-19 |