| NPI | 1336516780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA JACKSON Office Manager 773-940-1612 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 036101658) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2015-09-01 |