| NPI | 1922836170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATEISHA NICOLE FORT CEO/Provider 708-668-6971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-11-03 |