| NPI | 1144643966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHUNGYOON HA Associate 815-338-1138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 019025426) |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2014-01-30 |