| NPI | 1336891266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY DAVIS Owner 630-204-0601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2022-01-21 |