| NPI | 1952308223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL COULSON Owner 815-748-8993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 999999999) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2009-08-19 |