| NPI | 1770763302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY DENNIS EBERLE Athletic Trainer / Owner 309-202-2955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.000841) |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2007-11-12 |