| NPI | 1619236692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE MILLER Chief Executive Officer 872-588-3012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: IL 001) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2022-07-21 |