| NPI | 1114342847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODNEY EARL WILLEY Owner 309-376-8385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 3272) |
| Enumeration Date | 2014-03-05 |
| Last Update Date | 2020-09-10 |