| NPI | 1730567207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUES A. GOURGUECHON Principal 312-203-9211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 178.010830) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2015-05-15 |