| NPI | 1750353454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY LYNN BENWARE Practice Manager 618-498-7108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QR1300X Clinic/Center, Rural Health | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2008-04-24 |