NPI | 1598951063 |
---|---|
Entity Type | Organization |
Authorized Contact | NICHOLE BARNETT Practice Manager 309-664-1007 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: IL 036110975) |
Enumeration Date | 2007-09-19 |
Last Update Date | 2013-07-16 |