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205 S Burns Ave Sparta IL 62286-1867 | |
(618) 443-2858 | |
(618) 939-4256 |
Full Name | |
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Speciality | Family Medicine |
Location | 205 S Burns Ave, Sparta, Illinois |
Authorized Official Name and Position | Kyle Dillman (SECRETARY / TREASURER) |
Authorized Official Contact | 8124507399 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 34156 Belfast ME 04915-0619 Ph: (812) 450-6815 | 205 S Burns Ave Sparta IL 62286-1867 Ph: (618) 443-2858 |
NPI Number | 1225754526 |
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Provider Enumeration Date | 10/18/2022 |
Last Update Date | 12/02/2022 |
Identifier | Type | State | Issuer |
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1225754526 | NPI | - | NPPES |