| NPI | 1871241729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE BURROUGHS Clinic Executive 618-694-0739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2022-03-21 |