| NPI | 1083970255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONSTANCE HORENKAMP Business Manager 309-662-2833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 019.013846) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2012-04-02 |