| NPI | 1114438769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARRA GRANT Practice Manager 815-900-9060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology |
| Enumeration Date | 2017-10-21 |
| Last Update Date | 2025-03-07 |