| NPI | 1821048786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JEAN OSTRANDER Manager Provider Enrollment 773-834-4508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-11-03 |