| NPI | 1114759297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH SEELOW Credentialing COO Rdinator 815-650-0886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health |
| Enumeration Date | 2024-08-16 |
| Last Update Date | 2024-09-17 |