| NPI | 1194930644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE A WALTERS Practice Manager 847-433-3060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 042006963) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2010-12-20 |