| NPI | 1619626827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN STRICK Medicaid Manager 708-334-0465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2400X Clinic/Center, Prison Health |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2022-04-05 |