| NPI | 1215499884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIKA KIRSTON VAN WAGNER VP Of Development 815-496-6004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2020-05-13 |