| NPI | 1972850949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD BRYANT COLOSI President 847-542-4868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IL 070014101) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2012-08-09 |