| NPI | 1639134117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES E MARTINEZ Athletic Trainer 217-358-2805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 096.002229) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2020-08-22 |