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141 Market Pl Fairview Heights IL 62208-2034 | |
| (314) 238-5260 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 141 Market Pl, Fairview Heights, Illinois |
| Authorized Official Name and Position | Ryan W Morris (REGISTER AGENT) |
| Authorized Official Contact | 3142385260 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
141 Market Pl Fairview Heights IL 62208-2034 Ph: (314) 238-5260 | 141 Market Pl Fairview Heights IL 62208-2034 Ph: (314) 238-5260 |
| NPI Number | 1972074516 |
|---|---|
| Provider Enumeration Date | 12/07/2018 |
| Last Update Date | 08/27/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972074516 | NPI | - | NPPES |
| 1164929055 | Medicaid | IL |
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