| NPI | 1407033616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA ANN FARMER President/CEO 309-450-4773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CA EAP11798F) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2020-08-25 |