| NPI | 1235329749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICA ANN STOVELL Owner 773-994-9440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 036-082065) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2008-09-10 |