NPI | 1376283614 |
---|---|
Entity Type | Organization |
Authorized Contact | ANTHONY DAVENPORT Administrator 773-412-4653 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
Enumeration Date | 2022-04-01 |
Last Update Date | 2022-07-01 |