| NPI | 1992237051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CARLSON Hshs Chief Physician Executive 217-492-9169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 26-3956318) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2017-03-29 |