| NPI | 1881076859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LENCE Chief Executive Officer 618-889-9570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 164.006153) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2015-06-25 |