| NPI | 1003270802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL AHEARN Business Owner 309-883-9330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036074050) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2016-04-07 |