| NPI | 1912330317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELINDA CLARK CEO 217-523-5406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2016-08-03 |