| NPI | 1891921623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL MCREYNOLDS Billing/Provider Services Mgr 773-705-2260 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2013-08-06 |