| NPI | 1912693912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROMAN CRIOLLO COO 217-480-7298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-11-11 |