| NPI | 1669657995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY JAMES SMITH Owner 630-640-9073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 038-009491) |
| Enumeration Date | 2008-01-06 |
| Last Update Date | 2019-03-28 |