| NPI | 1912277716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES B. DAVIS Executive Director 618-257-4644 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036129376) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2013-02-19 |