| NPI | 1699751289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE ANN FRYE Business O Ffice Manager 309-663-1997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 7002413) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2010-01-06 |