| NPI | 1023559705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY GILMORE Clinical Director 773-332-3058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 149018731) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2017-03-15 |