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 |