| NPI | 1053338798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNNETTE MCROY Billing Coordinator 773-767-3822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036035346) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2010-03-24 |