| NPI | 1306516075 |
|---|---|
| Doing Business As | WILL GRUNDY MEDICAL CLINIC, LTD |
| Entity Type | Organization |
| Authorized Contact | LASHAWN WEST Executive Director 815-726-5112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2021-09-15 |