| NPI | 1003239252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA SUE WENDT Co Owner 217-202-9506 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 180.006584) |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2014-01-23 |