| NPI | 1063558328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA J DUNHAM Financial Director 217-431-2662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: IL 036-063740) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2016-05-03 |