| NPI | 1184853137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALLACE L VINSON Certified Surgical Assistants 630-780-8642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: IL 3408) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2009-07-13 |