| NPI | 1104845189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA LYNNE POESCH Physician/Owner 309-277-0772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 036070857) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-08-22 |