| NPI | 1619390671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAQUEL LOPEZ President/ Registered Dietitian 708-527-0772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 164.005838) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2014-01-28 |