| NPI | 1629003074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAMON R HARBISON President 618-436-6205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: IL 0002642) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2023-11-27 |