| NPI | 1336181544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA A EDINGTON Administrator 217-477-4750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: IL 060000812) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2008-11-25 |