| NPI | 1023206265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON WOODYATT Owner 815-636-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IL 038009877) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: IL 038009629) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2008-10-28 |