NPI | 1023708880 |
---|---|
Entity Type | Organization |
Authorized Contact | MARY GARRISON CEO 217-362-6262 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
Enumeration Date | 2023-05-15 |
Last Update Date | 2023-06-01 |