| NPI | 1497817142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLE GOMEZ OTAYCO COO 217-273-7718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2025-08-26 |