| NPI | 1104857341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE D. KING Owner 773-667-0768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036096686) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-12-03 |