| NPI | 1629314323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYLISHA WILLIS Operations Manager 312-842-4498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 1-11-8171) |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2015-01-22 |