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4033 S Illinois Ave Carbondale IL 62903-8375 | |
(618) 529-4151 | |
(618) 529-4154 |
Full Name | |
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Speciality | Clinic/center - Student Health |
Location | 4033 S Illinois Ave, Carbondale, Illinois |
Authorized Official Name and Position | William E Laser (ACCOUNTANT) |
Authorized Official Contact | 6185294151 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4033 S Illinois Ave Carbondale IL 62903-8375 Ph: (618) 529-4151 | 4033 S Illinois Ave Carbondale IL 62903-8375 Ph: (618) 529-4151 |
NPI Number | 1528234499 |
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Provider Enumeration Date | 05/01/2008 |
Last Update Date | 05/01/2008 |
Identifier | Type | State | Issuer |
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1528234499 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |
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