| NPI | 1972843613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN LEE President 618-244-3668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 016003846) |
| Enumeration Date | 2013-02-17 |
| Last Update Date | 2014-05-16 |