NPI | 1780715292 |
---|---|
Entity Type | Organization |
Authorized Contact | SOL BICOMONG DAYA Medical Doctor 815-444-1913 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 036048265) |
Enumeration Date | 2007-03-08 |
Last Update Date | 2020-08-22 |