| NPI | 1750799441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA MARTIN Coordinator 217-617-5268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: IL 3204) |
| Enumeration Date | 2014-07-26 |
| Last Update Date | 2014-07-26 |