| NPI | 1497807689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VENITA EDWARDS-TALLEY Clinic Physician 217-425-9642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 36117078) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2008-05-01 |