| NPI | 1073770459 |
|---|---|
| Other Name | NONE |
| Entity Type | Organization |
| Authorized Contact | ISABELO M EVANGELISTA Medical Doctor 847-828-3847 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2022-07-21 |