| NPI | 1487022752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVERNE BARNES Physician 708-720-5161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036110716) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2015-09-03 |