| NPI | 1821277658 |
|---|---|
| Doing Business As | SIHF PSR CLUB HOUSE FACILITY |
| Entity Type | Organization |
| Authorized Contact | LARRY MCCULLEY COO 618-332-0694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2007-10-29 |