| NPI | 1821413683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL EDWARD MCGOVERN Owner 847-255-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 038010766) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2014-03-03 |