| NPI | 1952099145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY THEUS Owner 630-631-6160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| 261QC1500X Clinic/Center Community Health | |
| 261QI0500X Clinic/Center Infusion Therapy | |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2024-10-10 |