Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Aug 18, 2005
License(s)
036-076085 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 311 W LINCOLN ST STE 200 | Belleville, IL 62220-1902 | 618-234-2566 |
| MAILING | 311 W LINCOLN ST SUITE 300 | Belleville, IL 62220-1902 | 618-234-2566 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.