| NPI | 1356526040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY GRANT BOERGER President 815-626-0212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 038-009964) |
| Enumeration Date | 2008-01-01 |
| Last Update Date | 2008-01-01 |