| NPI | 1801014295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERRY AYLWARD Owner 708-456-5454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 019018529) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |