| NPI | 1699061259 |
|---|---|
| Doing Business As | SOUTHERN ILLINOIS SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | JASON DANIEL NOELDNER Athletic Trainer 618-236-2246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096002594) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2011-06-22 |