| NPI | 1902188857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BINVERSIE Owner 618-967-9494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 038012019) |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2011-09-16 |