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 |