| NPI | 1366638751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD CEVENE Clinic Director 815-639-9900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 000000000) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2007-09-19 |