| NPI | 1770468621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON PAUL WISINSKI Medical Director 815-529-5949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2025-08-09 |
| Last Update Date | 2025-08-09 |