| NPI | 1013257989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY M SPOONER Provider Enrollmenr 630-978-2532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2013-02-28 |
| Last Update Date | 2025-12-26 |