| NPI | 1316146533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTI K GILL Administrator 708-333-8653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2009-02-05 |