| NPI | 1831254234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY MCCULLEY CEO 618-332-0694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 363LS0200X Nurse Practitioner School |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2013-02-25 |