| NPI | 1447597174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL FULWILER CEO 773-584-6130 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2013-01-15 |