| NPI | 1548763238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA R ANDRICKS CEO 217-877-9117 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2022-07-21 |