| NPI | 1497079636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER BELLUCI-JACKSON Medical Director 847-526-2151 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2010-03-17 |
| Last Update Date | 2011-03-01 |