| NPI | 1063124865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUTUMN PULLEN Chief Operating Officer 309-665-0206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2022-12-23 |
| Last Update Date | 2022-12-23 |