| NPI | 1649677063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY HUNT HALLER Member 217-342-3337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2023-11-08 |