| NPI | 1457631475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BOZZONE Executive Director 815-886-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036124389) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2011-11-08 |