| NPI | 1811087604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHON BROOKS V President 618-797-0618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036099405) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 036099405) |
| 207Q00000X Family Medicine (Licence: IL 036085633) | |
| 225100000X Physical Therapist (Licence: IL 070008964) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2024-08-06 |