| NPI | 1447388392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENT ALAN TARRO Administrator 217-854-3223 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: IL 005) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2025-04-04 |