| NPI | 1043481765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENIO SIERRA Administrator 847-599-3855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 019.026605) |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2008-03-20 |