| NPI | 1043548563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN BATIFORA DISTRITO Owner 815-885-2820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IL 1990943) |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2009-11-20 |