| NPI | 1326291451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | A MELISSA LOPEZ President 773-758-2010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019025964) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2012-08-16 |