| NPI | 1265054803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIDA VODOPALAS-PUODZIUNAS Owner 815-603-9683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-05-16 |
| Last Update Date | 2023-08-23 |