| NPI | 1124579073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL FITZGERALD JORDAN Dui / Treatment Provider 312-451-5184 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 302F00000X) |
| Enumeration Date | 2016-10-16 |
| Last Update Date | 2016-10-16 |