| NPI | 1922410836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN G LEE Physician Services Officer 217-479-5890 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2014-06-02 |