| NPI | 1780967414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK EMMET RUND Supervisor Of Clinical Services 773-382-4615 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2011-09-20 |