| NPI | 1821066515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L VAN METER Administrator 618-993-1112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 7002801) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2013-10-17 |