NPI | 1063652873 |
---|---|
Entity Type | Organization |
Authorized Contact | TRACY C BRITO Owner 815-987-1802 |
Organization Subpart ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036074111) |
Additional Taxonomies | 202K00000X (Licence: IL 036074111) |
Enumeration Date | 2009-03-06 |
Last Update Date | 2009-06-04 |