| NPI | 1770907289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY WILSON Physician 815-773-7469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: IL 036.130543) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2014-02-05 |