| NPI | 1700104064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD WILLIAM HANKINS President 309-829-1010 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 038003573) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2010-05-12 |