| 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 Phlebology (Licence: IL 036074111) |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2009-06-04 |