| NPI | 1578846465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERISE ELMORE Medical Billing Manager 708-798-8112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2012-09-18 |