| NPI | 1639660244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA JONES Billing Manager 618-939-4444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL A-0112-0001-A) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2018-05-21 |