| NPI | 1841526290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA G WILSON Financial Coordinator 618-692-1044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 003853) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2013-02-26 |