| NPI | 1881724565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKKI DAWN STRAIN Administrative Assistant 618-244-8070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2015-07-31 |