NPI | 1043757107 |
---|---|
Entity Type | Organization |
Authorized Contact | BRIAN WILLS Owner 815-562-5333 |
Organization Subpart ? | No |
Primary Taxonomy | 208D00000X General Practice |
Additional Taxonomies | 363L00000X Nurse Practitioner |
Enumeration Date | 2017-01-27 |
Last Update Date | 2017-01-27 |