| NPI | 1659392751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY AMMONS Manager 312-280-0996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036059654) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2010-07-29 |