| NPI | 1083615470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA GILL Administrator 708-771-3334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 7002561) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2018-03-30 |