Organization
PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD
Active
Parent organization
PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD
Authorized official
DR. BUD CHOMBIRUN M.D. (MEDICAL DIRECTOR)
(618) 877-4000
Entity
Organization
Contact information
Practice address
2861 MADISON AVE, GRANITE CITY, IL 62040-3614
(618) 877-4000
Mailing address
2980 N BEVERLY GLEN CIR, SUITE 301, LOS ANGELES, CA 90077-1726
(310) 474-9809
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Enumeration date
01/31/2012
Last updated
01/31/2012
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