| NPI | 1679159941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOHNSON Manager 618-277-9533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-03-18 |
| Last Update Date | 2021-05-05 |