| NPI | 1699142612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL ELIZABETH CANDLER Nurse Practitioner 618-741-4454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 209012741) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2015-08-25 |