| NPI | 1437519410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALYA SMIRNOVA Office Manager 708-788-7246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 036108759) |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2016-03-03 |