| NPI | 1982659991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA ANNE HASTY Practice Administrator 309-655-7704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: IL 042007027) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2007-11-12 |