NPI | 1154798916 |
---|---|
Entity Type | Organization |
Authorized Contact | ANNETTE OLIN Medical Director 815-494-1594 |
Organization Subpart ? | No |
Primary Taxonomy | 251V00000X Voluntary or Charitable |
Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
Enumeration Date | 2015-08-27 |
Last Update Date | 2015-08-27 |