| NPI | 1619322773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN J ACIERNO Manager 630-339-3172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 019015107) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: IL 019029436) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2016-04-26 |