| NPI | 1104899871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLA KAY WILSON President 217-522-3622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: IL 016-004880) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2011-03-25 |