| NPI | 1760619571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK E BEAUDOIN Owner 708-293-8800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 209000346) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2009-06-18 |