| NPI | 1699052621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP L SCHAEFER Board Member 618-549-5361 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 7003128) |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2011-11-04 |