| NPI | 1235423427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE ELIZABETH LEVERENZ CEO/Owner 217-446-6848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IL 149011254) |
| Enumeration Date | 2011-06-05 |
| Last Update Date | 2011-06-05 |