| NPI | 1366872061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIWANI COOPER Credentialing Specialist 872-588-3027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 209010903) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2013-11-15 |