| NPI | 1912736596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN M TAYLOR Revenue Cycle Credentialing Special 618-512-1803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2024-07-31 |
| Last Update Date | 2024-07-31 |