| NPI | 1174750426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY C. FUNG President 708-383-8228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019018956) |
| Enumeration Date | 2009-06-14 |
| Last Update Date | 2009-06-14 |