| NPI | 1992259337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE PASENELLI CEO 224-504-2215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2016-08-14 |
| Last Update Date | 2024-05-06 |