| NPI | 1942611207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW ANTHONY ROECHNER President 815-725-8075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019-022413) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2014-05-08 |