| NPI | 1013238450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN D ANTOSK Billing Administrator 708-974-5104 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2010-06-21 |