| NPI | 1881942647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE A KEPPLER Director Of Clinical Integration 815-759-8039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2012-08-27 |