| NPI | 1306111349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL E ETCHISON Owner 815-524-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019.027903) |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2012-03-08 |