| NPI | 1528205168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY EASLEY Owner 815-725-5211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: IL 016-003985) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2009-01-20 |