| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 55 W 22nd St, Lombard, Illinois |
| Authorized Official Name and Position | Corita Crumpton (CEO) |
| Authorized Official Contact | 7735738587 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
55 W 22nd St Lombard IL 60148-4854 Ph: (630) 448-2721 | 55 W 22nd St Lombard IL 60148-4854 Ph: (630) 448-2721 |
| NPI Number | 1598403313 |
|---|---|
| Provider Enumeration Date | 05/23/2022 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/22/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598403313 | NPI | - | NPPES |
| 000000 | Other | N/A |
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