| NPI | 1497055032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK D WALLERY CEO / President 773-283-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2010-10-29 |