NPI | 1164749594 |
---|---|
Entity Type | Organization |
Authorized Contact | FRANCISCO AVALOS Medical Director 708-222-9193 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036-114621) |
Enumeration Date | 2010-04-25 |
Last Update Date | 2010-12-04 |