| NPI | 1205401809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK PONZIANO Manager 773-981-0620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-05-25 |