| NPI | 1790096865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLENA BANSA Executive Director 773-338-8603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IL 3000609) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2010-06-23 |