| NPI | 1477900785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL C TYDELL Owner 847-946-8871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036139402) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2016-05-17 |