| NPI | 1750553749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID LARRY MITCHELL Physician/President 618-277-3197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036105470) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2008-03-31 |