| NPI | 1750807558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE GRAY President 815-962-0633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036072289) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2017-08-14 |