| NPI | 1447685524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY W SMART Manager 309-846-1215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: IL 038011302) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2013-09-09 |