| NPI | 1376698563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEROME WILSON Manager 773-354-8990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085-001943) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-08-22 |