| NPI | 1952656035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA DERYLO Administrator 847-571-3045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2021-04-28 |