| NPI | 1184754137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN JEFFREY BURGE President 309-347-8590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 195532) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-08-22 |