| NPI | 1609211218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN JON PORCHER President/Owner 847-342-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 038012410) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2018-03-17 |