| NPI | 1689896961 |
|---|---|
| Doing Business As | GLEN AVENUE FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | SUSAN LAFOLLETTE Billing Manager 309-671-8749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036067626) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2008-06-30 |