| NPI | 1053731760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL J LEANDER Owner 773-807-7734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 180-006834) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2014-04-21 |