NPI | 1467897710 |
---|---|
Entity Type | Organization |
Authorized Contact | LETA MARIE VAUGHAN President 224-635-8324 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: IL 209005087) |
Enumeration Date | 2013-04-30 |
Last Update Date | 2013-04-30 |