| NPI | 1437304946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE SHAW Office Manager 847-853-4405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 070007665) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: IL 070007771) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2008-11-25 |