| NPI | 1386298362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON KNOX Manager 708-424-0900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2019-07-29 |