| NPI | 1578708707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE STANSBURY President 773-276-0633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019016644) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2008-12-02 |