| NPI | 1134364318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE BERNARD BUCHANAN Resident Physician 708-422-5700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 125053019) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2008-12-02 |