| NPI | 1811397136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA ELIZABETH BRADLEY Clinic Owner 815-547-6333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 038012666) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2025-02-24 |