| NPI | 1114471737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY MOORE VP, Finance, CAO 217-223-8400 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 2085R0001X (Licence: IL 0000141) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2021-01-07 |