NPI | 1316071715 |
---|---|
Entity Type | Organization |
Authorized Contact | GARY JOHN THOMAS Provider 708-429-5968 |
Organization Subpart ? | No |
Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 37-1381196) |
Enumeration Date | 2007-03-15 |
Last Update Date | 2020-08-22 |