| NPI | 1649651951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE LAVINE Medical Director 815-477-8844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain (Licence: IL 036-049364) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2016-09-01 |