| NPI | 1174753735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONYA LETRECE THOMAS Director 773-277-2227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: IL 036093278) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: IL 036093278) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2010-11-17 |