| NPI | 1649558305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM MUSCATO Billing Manager 815-634-3048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 070013720) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2015-01-28 |