| NPI | 1285819342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERISA C. JOHNSON Physician Owner 773-629-0524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 036119674) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2008-01-08 |