| NPI | 1659500833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J MAICHLE BACON Administrator 815-720-4011 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health (Licence: IL 771115034) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2012-12-12 |