| NPI | 1760408439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGIE JOHNSON Executive Director 773-651-3828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: IL 261QP2300X) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2011-10-20 |