| NPI | 1699206599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID M CONNER Owner 618-222-9383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 036081648) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2017-03-22 |