| NPI | 1013217785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY MALIK Administrator 773-735-8182 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036070270) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2011-02-09 |