| NPI | 1962643072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEILA I KAYSER CEO 815-301-7809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 227.003938) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: IL 198.000709) |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2009-03-19 |