| 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 |