| NPI | 1538432075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIONISIO U. DEGRACIA Owner 309-764-3711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2012-02-14 |