| NPI | 1457330870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SABRINA MODRE CFO 773-702-2193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2009-10-01 |