| NPI | 1306231147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA SULLIVAN Market Manager 224-500-7627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IL 209008821) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2015-03-30 |