| NPI | 1013045707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY M MARTIN Controller 708-747-7100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: IL 041) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2022-07-21 |