| NPI | 1699061929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN PATRICK SORIANO President 847-429-9845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 042619763) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036119056) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2011-06-24 |