NPI | 1063538312 |
---|---|
Entity Type | Organization |
Authorized Contact | STONEWALL MCCUISTON President 815-933-0194 |
Organization Subpart ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036074737) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036074737) |
Enumeration Date | 2007-03-21 |
Last Update Date | 2010-10-20 |