| NPI | 1902402597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRIN RAY Physician Owner 815-566-9915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2025-09-10 |