| 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 |