| NPI | 1588405070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY VANHAUEN Credentialing Specialist 815-713-2651 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2024-06-06 |