NPI | 1619013265 |
---|---|
Entity Type | Organization |
Authorized Contact | GREGORY ANDERSON Owner 618-654-3400 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 036117202) |
Enumeration Date | 2007-01-30 |
Last Update Date | 2008-02-12 |