| NPI | 1699407643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE L MCGINNESS Owner/Medical Director 618-622-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-06-28 |