| NPI | 1811560782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DAVID CHURCH Vice President Of Finance 618-972-5228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2024-10-03 |