| NPI | 1912211202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES B. DAVIS Executive Director 618-257-4644 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2013-02-22 |