| NPI | 1639928096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIAN XIA Owner 312-842-4588 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2024-05-16 |
| Last Update Date | 2024-05-16 |