| NPI | 1881835577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTY KRUEGER Managed Care Coordinator 217-784-2364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 209002058) |
| Enumeration Date | 2009-03-10 |
| Last Update Date | 2017-10-24 |