| NPI | 1538398656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE TABELS Credentialing & Privileging 217-554-5383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: IL 164000383) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2009-07-10 |