| NPI | 1447642384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN KELSO SCHULTZ President 309-663-1721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 019.018656) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2015-03-02 |