| NPI | 1184895765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REID HERMAN HANSEN Owner 309-637-3500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IL 036064366) |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2008-03-21 |