| NPI | 1790968709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON ALAN MALAVOLTI President/Owner 773-575-5112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 038-009815) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2007-12-12 |