| NPI | 1982666384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA K FLAMM CEO 618-833-4471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2016-04-25 |