| NPI | 1124902994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE WASCHER Advanced Practice Nurse 815-573-8464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-08-04 |