| NPI | 1174699276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTA EVERLING Office Manager 815-395-0100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036054745) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036055330) |
| 174400000X Specialist (Licence: IL 036082303) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-18 |