| NPI | 1548157340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE JACKSON Manger 312-526-2279 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-06-23 |
| Last Update Date | 2025-06-23 |