| NPI | 1639359797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNE R LUSINGER Office Manager 815-729-0330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 036085910) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2008-04-20 |