| NPI | 1013750009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUKESHA TATE Executive Director/Owner 708-566-1185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 174200000X Meals |
| 261QM2500X Clinic/Center Medical Specialty | |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-07-15 |