| NPI | 1245403542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID RAYMOND KOPACZ Owner 217-363-2891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: IL 036093022) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2008-04-08 |