| NPI | 1932383734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD A DEYO Owner 815-244-2091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 038003275) |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2007-12-28 |