| NPI | 1457554552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA CATHERINE COURI Owner 309-682-5522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019024444) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2020-08-22 |