| NPI | 1740596394 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | JULIA LYNN PHILLIPS Dietetic Technition Registered Nutr 618-410-4236 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: IL 302R00000x) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2010-08-20 |