| NPI | 1063996239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRAINNE MCKEOWN Provider 773-338-2309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2019-03-15 |