| NPI | 1376821025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEGAULLE G HAILE Managing Member 815-935-1315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: IL 036110330) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2011-07-29 |