| NPI | 1780006619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY VILLASENOR Family Practice 708-788-2801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-111596) |
| Enumeration Date | 2014-01-12 |
| Last Update Date | 2014-01-12 |