| NPI | 1891357406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN KIDD Chief Operating Officer 217-821-0759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2019-07-03 |