| NPI | 1336175801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY MATTSON Owner 847-932-1079 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 042-617702) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2011-01-25 |