| NPI | 1639836679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ELMER Credenitaling And Risk Manager 815-381-7431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-11-24 |
| Last Update Date | 2021-11-24 |