| NPI | 1104239623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENNADY BOLDETSKY President 847-366-9518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: IL 198001173) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2014-06-03 |