| NPI | 1518313287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSVALDO H WESLY Medical Director 217-546-7100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036.089289) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2016-05-11 |