Organization
TRANSACTIONS IS ACCURATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIA SCOTT (DIRECTOR)
(773) 960-1656
Entity
Organization
Contact information
Practice address
14419 S SAGINAW AVE, CHICAGO, IL 60633-2009
(773) 960-1656
Mailing address
14419 S SAGINAW AVE, CHICAGO, IL 60633-2009
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
01/20/2022
Last updated
01/20/2022
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