| NPI | 1023281722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY GRAY WHITE Owner/Doctor 773-821-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2008-04-03 |