| NPI | 1225214323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JOSEPH COYNIK Oficer 815-223-6975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 036055725) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2009-05-18 |