| NPI | 1831475532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY KENT STOUT President 309-454-8622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 038-005470) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2013-02-26 |