| NPI | 1497982037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIOLA MJALTAJ Resident 773-704-6643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 125.056297) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2009-06-22 |