| NPI | 1588894497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT TANNER President/CEO 847-608-6068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2009-07-27 |