Organization
JERSEYVILLE PAIN MANAGEMENT CENTER, S.C.
Active
Parent organization
JERSEYVILLE PAIN MANAGEMENT CENTER, S.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
JERSEYVILLE PAIN MANAGEMENT CENTER, S.C.
Authorized official
DR. BUD CHOMHIRUN M.D. (MEDICAL DIRECTOR)
(618) 259-3321
Entity
Organization
Contact information
Practice address
1702 VAUGHN RD, WOOD RIVER, IL 62095-1898
(618) 259-3321
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
12/01/2011
Last updated
01/03/2012
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