| NPI | 1396082087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA A GATES Owner/Practitioner 815-288-1235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 149010806) |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2013-01-15 |