Organization
CABS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME CLARK (STUDENT INTERN)
(847) 377-8950
Entity
Organization
Contact information
Practice address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8950
Mailing address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/21/2013
Last updated
06/21/2013
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