| NPI | 1134451594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUSTAVO A PEDRAZA President 815-467-4114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036076520) |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2010-02-09 |