| NPI | 1114150893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY HUMES Director 309-797-4688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036088031) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2009-08-28 |