| NPI | 1619009578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT J. JOHNSON President 309-347-7051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 060-007291) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2020-08-22 |