| NPI | 1487996872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY R WILSON President 773-552-1243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209008802) |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2015-08-14 |