| NPI | 1104314608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN GOULDER Owner/Medical Director 312-498-4409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2018-04-30 |