| NPI | 1356601629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN CHRISTOPHER SNIDER Owner 309-678-4243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 209005824) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-05-21 |