| NPI | 1336408517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IDA M DIXON President 773-285-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 209009287) |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2012-05-09 |