| NPI | 1134498645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS V CARTER Owner 815-740-1987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IL 238000300) |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2011-12-29 |