| NPI | 1104306240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE LYNN BROCK Sole Member 847-903-0503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: IL 1640006979) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2020-10-10 |