| NPI | 1710493572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUBASHER FEROZE Manager 773-414-9438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251V00000X Voluntary or Charitable |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2017-12-15 |