| NPI | 1174900013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN J ACIERNO Manager 630-339-3172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 019028070) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: IL 019028928) |
| 305R00000X Preferred Provider Organization (Licence: IL 019028439) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-04-29 |