| NPI | 1699866681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE A JOHNSON Practice Administrator 815-637-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 0030559-6) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2008-02-15 |