| NPI | 1790189462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE JONES President 815-332-6801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 1053487942) |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2014-10-09 |