| NPI | 1871548859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA JAY BLETZINGER President 630-761-9702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 038-010143) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2009-06-09 |