| NPI | 1205017597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILFREDO GRANADA Physician 847-872-5556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036048709) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2008-01-31 |