| NPI | 1184991465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN WIDEMAN Associate Dean, Faculty Practice 312-942-7013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: IL 209002261) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2011-11-30 |