| NPI | 1407835200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTICE AARON GONDWE President 309-792-8545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 036108111) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036108111) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2020-08-22 |