| NPI | 1629846928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER HENRY CEO 217-403-5401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2023-12-15 |
| Last Update Date | 2024-06-03 |