| NPI | 1740516418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK EDWARD BENSON President/Dr. 224-489-2884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WI 4542-12) |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2009-10-30 |