| 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 |