| NPI | 1104609544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY GARRISON CEO 217-362-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2023-08-17 |