| NPI | 1588073753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY GWINN Manager 618-235-0126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care (Licence: IL ADS1008005) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2014-08-12 |