| NPI | 1508355876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIAN XIA Owner 312-842-4588 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: IL 036105506) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 036105506) |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2024-05-16 |