| NPI | 1992154991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID DEMOULIN President/Owner 630-269-9435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 038012948) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2016-06-09 |