| NPI | 1023556164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMERON ROBERT MACKICHAN Owner 217-281-0006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 038.012800) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2018-01-16 |