| NPI | 1952934200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY D PHILLIPS Revenue Cycle Department Manager 618-937-6483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-02-14 |
| Last Update Date | 2020-02-14 |