NPI | 1225490915 |
---|---|
Entity Type | Organization |
Authorized Contact | WAYNE SPICER Registered Agent 217-801-1242 |
Organization Subpart ? | No |
Primary Taxonomy | 251S00000X (Licence: IL 149.016405) |
Additional Taxonomies | 251S00000X (Licence: IL 149.018235) |
Enumeration Date | 2016-03-22 |
Last Update Date | 2023-05-04 |