| NPI | 1962582700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELBERT ALVIN FASNACHT President 618-457-4999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036075250) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2009-09-10 |