| NPI | 1992829485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL A SHADLEY Administrator 309-693-8611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: IL 042.007981) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |