| NPI | 1922574391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN KIDD Owner/Chief Operating Officer 217-821-0759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2018-10-23 |