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1902454689
LIGHT SOURCE LLC
BELLEVILLE, IL
NPI
1902454689
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Entity Type
Organization
Authorized Contact
CHARLES FRANKE
Lcsw/Owner
618-444-9934
Organization Subpart ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
Enumeration Date
2019-08-27
Last Update Date
2019-08-27
Business Address
LIGHT SOURCE LLC
114 E LINCOLN ST
BELLEVILLE, IL 62220-2251
Phone number: 618-444-9934
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Mailing Address
LIGHT SOURCE LLC
114 E LINCOLN ST
BELLEVILLE, IL 62220-2251
Phone number: 618-444-9934
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