| NPI | 1598833659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEKELA ROCHELLE SCOTT Clinical Supervisor 773-788-9374 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IL 70012853) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-08-22 |