| NPI | 1942482278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE KITAI PARK Medical Doctor 630-325-8681 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036-080235) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2013-02-28 |