| NPI | 1649429812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE L PRUIM Administrator 815-941-3113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0905X Clinic/Center, Public Health, State or Local |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2019-08-20 |