| NPI | 1710717285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCELLA KLAUER Adminstrative Quality Assistant 773-572-5480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-08-07 |