| NPI | 1902139355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN BERT MILLER Owner 312-553-9504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036-037-128) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2012-09-21 |