| 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 |