| NPI | 1134512668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BORIS VELLER Owner 224-817-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: IL 038010408) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2015-06-23 |