| NPI | 1407073711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA GUREVICH Medical Administrator 847-702-9545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IL 036104844) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |