| NPI | 1609010859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMASITA A LAHUE Health Director 618-624-9384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: IL 042619407) |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2009-04-30 |