| NPI | 1376574814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTINE B CORDAY Board Executive 312-794-7730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MI 636917) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-08-18 |