| NPI | 1740543305 |
|---|---|
| Doing Business As | THE OTHERSIDE |
| Entity Type | Organization |
| Authorized Contact | LEONARD EUGENE DEFORGE Owner/Manager 217-607-0098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2012-06-20 |