| NPI | 1134424633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL D TARANTINO Medical Director 309-692-5337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 036101239) |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2021-07-30 |