| NPI | 1538123468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH BANNO CEO 309-692-9898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TH0100X Psychologist Health Service |
| Additional Taxonomies | 208800000X Urology |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2020-08-22 |