| NPI | 1942697735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL W BORVAN Vice President 708-253-7258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: NE ASC068) |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2017-10-09 |