| NPI | 1376832097 |
|---|---|
| Former Legal Business Name | RESURRECTION SERVICES |
| Entity Type | Organization |
| Authorized Contact | MELVONNE WICKLIFFE-JONES Credentialing Mgr 630-914-2417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036121594) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2013-04-10 |