| NPI | 1134280753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA L WELTER Director Full Service Unit 815-490-6752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |