| NPI | 1972630861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN WIDEMAN Director Faculty Practice/Outreach 312-942-7013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 209-002424) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2008-07-10 |