| NPI | 1376658658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LAWRENCE CFO 815-942-2932 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2025-08-08 |