| 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 |