| NPI | 1003900820 |
|---|---|
| Former Legal Business Name | SPORTS ENHANCEMENT CENTER, LLC |
| Entity Type | Organization |
| Authorized Contact | J. ANTHONY DUSTMAN President 309-663-9300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2017-09-12 |