| NPI | 1902269095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARENCE PARKS Pcp Family Practice Medicine 815-275-1540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: IL 1275992323) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2016-04-05 |