| NPI | 1104110758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSS A ROSENBERG Owner 847-749-0514 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 180002762) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2011-05-31 |