| NPI | 1932517919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW WILLSON Athletic Trainer 269-598-1758 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.003776) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2014-07-23 |