| NPI | 1609152867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN POTTOW President 773-283-2835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: IL 1011364) |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2012-05-11 |