| NPI | 1194825190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS KOURI Medical Doctor 309-689-9088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: IL 036071029) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2013-06-11 |