| NPI | 1396118543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN K FRIED Founder 217-480-0448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: VA 0102204075) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: VA 0102204075) |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2015-12-21 |