| NPI | 1558643734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXIS B OLSSON President 312-926-6333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: IL 021.001615) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |