| NPI | 1407686371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENZY LEE RICHARDSON Director Of Contract Administration 312-756-6230 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2024-08-06 |