NPI | 1821112046 |
---|---|
Entity Type | Organization |
Authorized Contact | MOHIN TISSA SAMARAWEERA Director 815-436-7303 |
Organization Subpart ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: IL 36048836) |
Enumeration Date | 2007-03-16 |
Last Update Date | 2007-09-12 |