| NPI | 1740661941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE M LAVINE Medical Director 815-477-8844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center Pain (Licence: IL 036-049364) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: IL 36.0422751) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2016-11-28 |