| NPI | 1659886513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YEUN KIM Billing Manager 815-348-5614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: IL 036093275) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: IL 036093275) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2024-08-01 |