| NPI | 1225279680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY DAWN KINIGAKIS Proprietor 815-618-8116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036-095213) |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2009-03-16 |