| NPI | 1356860571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL DIDOMINICIS Clinical Supervisor 847-628-2464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2017-09-19 |