| NPI | 1700065398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN A CHANASUE President 618-462-9623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 036060164) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2007-10-31 |