| NPI | 1639442536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANG PARK Owner 312-332-1450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 019025040) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2012-02-23 |