| NPI | 1790970390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL P DAVENPORT Owner/Provider 847-368-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 038-007628) |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2007-09-07 |