| NPI | 1649721531 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON TAYLOR Credentialing And Managed Care Spec 773-768-5000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2016-10-17 |