| 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 |