| NPI | 1649553892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERISE ELMORE Medical Billing Manger 708-798-8112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2012-09-18 |