| NPI | 1508977034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB A MATHEW Business Office Manager 708-632-5600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036055119) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-08-03 |