| NPI | 1336417724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS T DISTASIO Owner 217-544-8118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: IL 038003935) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: IL 198000025) |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2011-12-13 |