| NPI | 1477795839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH BRUNDAGE Practice Manager 708-366-7177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036-048665) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2009-04-01 |