| NPI | 1609937127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA G BOLEN Office Manager 618-549-8464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: IL 36112572IL) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-08-22 |