| NPI | 1598718603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH D MALAS CFO Authorized Official 815-971-6738 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: WI 310800) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-06-11 |