| NPI | 1720197601 |
|---|---|
| Doing Business As | PROVENA HEALTH CENTER FOR DIAGNOSTIC IMAGING |
| Entity Type | Organization |
| Authorized Contact | EDWARD MOLARE President 815-806-2309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |