| NPI | 1326370057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBY POPE CEO 224-656-1983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036102939) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: IL 85001395) |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2010-02-05 |