| NPI | 1881064681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON BODAM District Manager 847-284-2576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2015-10-06 |