| NPI | 1811940893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE L CARSON Billing Supervisor 618-628-8211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: IL 042007668) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2010-07-08 |