| NPI | 1730481375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK GENDLEMAN President 847-475-4556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 036045834) |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2010-12-02 |