| NPI | 1356640346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY A EDWARDS Manager/Counselor 309-752-9740 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL A-8601-0002-A) |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2011-03-16 |