| NPI | 1104030790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEILA D BAKER Medical Director 217-581-3015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health (Licence: IL E9988478107) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |