| NPI | 1720686496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FATIMA HATIA Owner 309-868-1522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2021-01-07 |