| NPI | 1639061757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA CLELAND Manager 618-980-2181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 111N00000X Chiropractor |
| 363L00000X Nurse Practitioner | |
| 208100000X Physical Medicine & Rehabilitation | |
| 207K00000X Allergy & Immunology | |
| Enumeration Date | 2025-07-15 |
| Last Update Date | 2026-05-18 |