| NPI | 1083063945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETSY MARTINEZ Credentialing Specialist 847-315-7980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: FL 1956765) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2016-06-10 |