| NPI | 1588068555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA YATES Director Of Business Services 815-999-3001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2014-10-20 |