NPI | 1912382227 |
---|---|
Entity Type | Organization |
Authorized Contact | BURGUNDY JOHNSON Billing Manager 773-388-3491 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 251S00000X |
Enumeration Date | 2015-07-28 |
Last Update Date | 2023-05-10 |