| NPI | 1881255784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA COATES Manager 309-645-0689 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 261QS1200X Clinic/Center, Sleep Disorder Diagnostic |
| Enumeration Date | 2019-06-22 |
| Last Update Date | 2019-06-22 |