| NPI | 1063678530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY GARVEY CFO 708-754-1044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: IL 048) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2022-07-21 |