| NPI | 1194168823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA DANIELS Behavior Specialist 217-317-9688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2013-04-11 |