| NPI | 1871706374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY D LISENBY Office Manager 618-244-7788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: IL 036060706) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2008-04-20 |