| NPI | 1215305842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISABEL F FAIRCLOTH President 312-714-7712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IL 209005626) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-09-14 |