| NPI | 1568742542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH J HENNESSY President 312-780-2301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 036082176) |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2011-08-23 |