| NPI | 1679753123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENECSIS CASTRO-SKOGLUND Owner 309-689-8370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 036093944) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2007-11-13 |