| NPI | 1942312442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRI R HENSON Executive Director 618-463-8634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0206X Clinic/Center, Radiology, Mammography (Licence: IL 100867) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-071248) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-08-30 |