| NPI | 1649573882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LOUISE KELLY President 708-848-0040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036077560) |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2013-12-18 |