| NPI | 1407928807 |
|---|---|
| Doing Business As | CLINIC |
| Entity Type | Organization |
| Authorized Contact | WILLIAM BLAKE Principal Officer 312-842-3700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-08-22 |