| NPI | 1366701534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENEE' MICHELLE FOISY Case Manager 309-532-7915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN 0130900) |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2014-05-19 |