| NPI | 1134550775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA MAY GOUDSCHAAL Owner/Clinical Manager 847-602-0080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 056-005426) |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2013-12-09 |