| NPI | 1780990051 |
|---|---|
| Doing Business As | SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | PHILLIP EDWARD VOORHIS Assistant Athletic Director 815-753-0211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: IL 096000344) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2010-08-25 |