| NPI | 1255603247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAVIER FLORES Owner 773-942-6141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-116087) |
| Additional Taxonomies | 202K00000X (Licence: IL 036-116087) |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2021-02-09 |