| NPI | 1336482462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL M. PETRAK Managing Partner 888-220-6432 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: IL 41053311) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2013-03-27 |