| NPI | 1922270008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY LEE WEATHERS President 773-775-2210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19014704) |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2008-03-28 |