| NPI | 1528489739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY D'COSTA Owner, Physician 815-733-6888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036116813) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2023-11-03 |