| NPI | 1881117125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES B DAVIS Executive Director 618-257-4644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2017-07-19 |