| NPI | 1043481179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN CLEO CIACCIO President 309-236-8075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2008-03-17 |