| NPI | 1922005776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH ONEAL CEO 815-986-0062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 36090521) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2020-08-22 |