| NPI | 1659741858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB BROWN Owner 847-208-0973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA CH 60520744) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2019-05-13 |