NPI | 1174932586 |
---|---|
Entity Type | Organization |
Authorized Contact | JENNIFER HENRY CEO 217-403-5401 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
Enumeration Date | 2014-08-11 |
Last Update Date | 2024-06-03 |