| NPI | 1548062318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDITH C EASTRIDGE Director Of Credentialing 312-432-7329 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-03-25 |
| Last Update Date | 2025-03-25 |