| NPI | 1588736847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISABELO CHRISTOPHER CASTILLO President 309-837-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 036089354) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2011-01-24 |