| NPI | 1720543721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANDICE KING Credentialing Specialist 847-228-3303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2020-06-26 |