| NPI | 1467179952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLEN HURTADO Billing Lead 847-608-6318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2022-10-25 |