| NPI | 1659638401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY MAE MAES President And Medical Director 217-442-0433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 036113601) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2013-07-01 |