| NPI | 1104193499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON CAREY CFO 847-608-6053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2021-05-27 |