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 |