| NPI | 1053506352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN LYNNE LABOUNTY Office Manager 309-663-2354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036058820) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2009-03-27 |