| NPI | 1740518380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAILIN SPENCER Director Of Medical Billing 309-282-8565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019019599) |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2013-04-25 |