| NPI | 1912027749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT TANNER CEO 847-608-1344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2020-08-22 |